Over the course of the past 7 years, we have conducted a series of studies of women with early stage breast cancer and their partners seeking to understand relationship support processes and to intervene with couples to determine if couple-focused group interventions are beneficial. Our results have underscored the importance of communication between partners particularly when the patient is sharing her concerns and /worries about breast cancer. The goal of the next proposed study in our program of research is to evaluate he efficacy of an enhanced couple-focused group intervention (ECG) against a Support Group intervention SG) and Usual Care (UC). ECG increases the emphasis on facilitating support and intimacy-building and stress management skills and practice and contains two more sessions. Our pilot data suggests that ECG has stronger effects than our prior couple-focused group intervention and also may impact partners. This study will advance our previous work by: 1) examining whether ECG has stronger effects on patient functioning than SG, which facilitates group support but does not target relationship support and stress management skills; 2) identifying the mechanisms of change for ECG versus SG; 3) evaluating the impact of ECG versus SG and UC on a broader range of outcomes including partner ratings of patient functioning, role/social functioning, treatment adherence, partner psychosocial functioning, and partner support and stress management skills; 4) identifying moderators for ECG and SG. 638 patients and their partners will be randomly assigned to ECG, SG, or UC. Couples will complete surveys pre-intervention, 1 week, 6 months and one year post-intervention. The primary aims are: 1) To evaluate the impact of ECG, SG versus UC on patients' psychological functioning; 2) To evaluate whether relationship support, relationship intimacy, stress management skills, and intervention group support mediate changes in patient functioning. A secondary aim examines the impact of the interventions on role and social functioning and treatment adherence. An exploratory aim evaluates the impact of ECG versus SG and UC on partner and couple-level functioning and on partner's perception of relationship support, intimacy, stress management, and intervention group support.